U.S. patent number 5,284,162 [Application Number 07/913,442] was granted by the patent office on 1994-02-08 for method of treating the colon.
Invention is credited to Peter J. Wilk.
United States Patent |
5,284,162 |
Wilk |
February 8, 1994 |
**Please see images for:
( Certificate of Correction ) ** |
Method of treating the colon
Abstract
A surgical instrument assembly and method particularly for
grasping and displacing a large tubular organ such as a colonic
section during a laparoscopic procedure comprises an elongate rigid
tubular member, an elongate rod having at least a portion slidably
inserted in the tubular member, and two or four prongs connected to
the rod at a distal end thereof. The prongs each have an arcuate
configuration when ejected from a distal end of the tubular member
by a distally directed motion of the rod. Upon ejection, the prongs
form a substantially C-shaped clamping member with a pair of
grasping jaws. The prongs are flattened out and pressed towards one
another when the distal end of the tubular member is shifted over a
proximal portion of the prongs.
Inventors: |
Wilk; Peter J. (New York,
NY) |
Family
ID: |
25433277 |
Appl.
No.: |
07/913,442 |
Filed: |
July 14, 1992 |
Current U.S.
Class: |
128/898;
606/205 |
Current CPC
Class: |
A61B
17/29 (20130101); A61B 2017/303 (20130101) |
Current International
Class: |
A61B
17/28 (20060101); A61B 17/30 (20060101); A61B
017/00 () |
Field of
Search: |
;606/140,141,205,206
;128/898 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kruter; Jerome L.
Attorney, Agent or Firm: Sudol; R. Neil Coleman; Henry
D.
Claims
What is claimed is:
1. A surgical method comprising the steps of:
inserting a distal end of an elongate tubular member into a
patient's abdomen;
ejecting from a distal end of said tubular member a pair of
prongs;
during said step of ejecting, spreading said prongs apart from one
another to form a pair of jaws;
moving said jaws towards a colon of the patient to insert a portion
of said colon between said jaws so that said jaws essentially
surround said colon;
shifting said tubular member towards said prongs, thereby at least
partially closing said jaws about said colon to essentially clamp
said colon between said jaws, thereby closing said colon at said
jaws.
2. The method defined in claim 1 wherein said prongs are connected
to an elongate rod member slidably inserted into said tubular
member, said step of ejecting including the step of pushing said
rod member in a distal direction through said tubular member.
3. The method defined in claim 2 wherein said prongs are integral
with one another and made of a resilient material having a limited
degree of flexibility, whereby said prongs may be collapsed towards
one another by being drawn into said distal end of said tubular
member, said step of spreading including the step of automatically
spreading said prongs under the action of internal stresses.
4. The method defined in claim 1 wherein said step of inserting
includes the step of inserting said tubular member through a trocar
sleeve into the patient's abdomen, said method being part of a
laparoscopic procedure.
5. The method defined in claim 1, further comprising the step of
displacing said colon relative to other organic tissues of the
patient by exerting a force on said tubular member and said jaws
upon completion of said step of closing.
6. A surgical method comprising the steps of:
inserting a distal end of an elongate member into a patient's
abdomen;
upon said step of inserting, opening a pair of opposed arcuate arms
of a C-shaped clamping member connected to said elongate member at
a distal end thereof, thereby forming a pair of jaws;
moving said jaws towards a colon of the patient to insert a portion
of said colon between said jaws so that said jaws essentially
surround said colon;
pressing said arms towards one another to partially flatten said
arms, thereby closing said clamping member about said colon to seal
said colon; and
repairing a perforation in said colon while said colon is clamped
by said jaws.
7. The method defined in claim 6 wherein said step of inserting
includes the step of inserting said elongate member through a
trocar sleeve into the patient's abdomen, said method being part of
a laparoscopic procedure.
8. The method defined in claim 6, further comprising the step of
displacing said organ relative to other organic tissues of the
patient by exerting a force on said elongate member and said
jaws.
9. A surgical method comprising the steps of:
providing two elongate members each having a pair of prongs and
means operatively connected to the respective prongs for
alternatively opening and closing the prongs;
inserting the distal ends of the two elongate members into a
patient's abdomen;
upon insertion of the distal ends of the two elongate tubular
members into a patient's abdomen, opening the prongs to form two
pairs of jaws;
moving said pairs of jaws towards a colon having a perforation to
insert a portion of said colon between each of said pairs of jaws
such that said jaws are located on opposite sides of said
perforation;
at least partially closing said pairs of jaws about the colon to
clamp the colon on opposite sides of the perforation; and
repairing the perforation while the colon is clamped by said
jaws.
10. The method defined in claim 11 wherein said elongate members
are tubular members, further comprising the step of ejecting the
prongs from the distal ends of the respective tubular members upon
insertion f the distal ends of the tubular members into the
patient's abdomen, said step of opening being executed upon said
step of ejecting.
11. The method defined in claim 10 wherein said pairs of prongs are
each connected to a respective elongate rod member slidably
inserted into the respective tubular member, said step of ejecting
including the step of pushing said rod member in a distal direction
through said respective tubular member.
12. The method defined in claim 11 wherein said step of closing
includes the step of moving said tubular members relative to
respective ones of said pairs of jaws, thereby drawing said prongs
into the distal ends of said tubular members.
13. The method defined in claim 9 wherein said step of inserting
includes the step of inserting said tubular members through trocar
sleeves into the patient's abdomen, said method being part of a
laparoscopic procedure.
Description
BACKGROUND OF THE INVENTION
This invention relates to a surgical instrument assembly and an
associated surgical technique.
During the performance of laparoscopic operations, it is frequently
necessary to move an organ such as an intestine or an artery in
order to reach an underlying organ. Such large tubular organs
cannot be easily manipulated in laparoscopic surgery. Existing
instruments such as grasping forceps have operating tips (e.g.,
jaws) which are basically too small to grasp a colon or major
artery and move the organ without injury thereto.
OBJECTS OF THE INVENTION
An object of the present invention is to provide a surgical
instrument or instrument assembly which may be used to grasp a
relatively large internal organ of a patient such as the colon or
the aorta.
A more particular object of the present invention is to provide
such a surgical instrument or instrument assembly which may be used
to partially shift larger internal organs of a patient.
Another, related object of the present invention is to provide such
a surgical instrument or instrument assembly which may be used in
laparoscopic surgery to grasp and partially shift a relatively
large internal organ of a patient such as the colon or the
aorta.
An associated object of the present invention is to provide a
surgical technique which may be used to grasp, clamp and optionally
shift a large internal organ of a patient such as the colon or the
aorta, particularly in laparoscopic surgery but not exclusively
limited thereto.
These and other objects of the present inventions will be apparent
from the following descriptions and the drawings.
SUMMARY OF THE INVENTION
A surgical instrument assembly comprises, in accordance with the
present invention, an elongate tubular member, an elongate rod
having at least a portion slidably inserted in the tubular member,
and two prongs connected to the rod at a distal end thereof. The
prongs each have an arcuate configuration when ejected from a
distal end of the tubular member by a distally directed motion of
the rod. Upon ejection, the prongs form a pair of grasping jaws.
The prongs are flattened out and pressed towards one another when
retracted into the distal end of the tubular member by a proximally
directed motion of the rod or, alternatively, when the tubular
member is pushed in the distal direction over proximal end portions
of the prongs.
Pursuant to a particular feature of the present invention, each of
the prongs has a flattened transverse cross-section with rounded
edges.
Pursuant to another particular feature of the present invention,
each of the prongs is one of a pair of prongs, whereby the rod is
provided at a distal end with two pairs of jaws.
A surgical instrument assembly comprises, in accordance with
another conceptualization of the present invention, an elongate
member provided at a distal end with a generally C-shaped clamping
member having a pair of opposed arcuate arms. The instrument
assembly further comprises a closure device associated with and at
least partially coextensive with the elongate member in a
longitudinal direction for pressing the arms towards one another to
partially flatten the arms, thereby closing the clamping member
about an object.
According to another feature of the present invention, the arms are
integral with the elongate member and with one another, the arms
being made of a resilient material having a limited degree of
flexibility and an internal spring force whereby the arms are
maintained in an opened configuration in the absence of a closure
force.
According to a further feature of the present invention, the
closure device includes a tubular member surrounding at least a
portion of the elongate member. The tubular member cooperates with
the arms in a camming action to press the arms towards one another
upon relative motion of the tubular member and the arms towards
each other.
According to additional features of the present invention, the
elongate member is a rod slidably inserted into the tubular member,
while each of the arms has a flattened transverse cross-section
with rounded edges. Moreover, each of the arms may be one of a pair
of arms, whereby the elongate member is provided at a distal end
with two pairs of jaws.
A surgical method comprises, in accordance with the present
invention, the steps of (a) inserting a distal end of an elongate
tubular member into a patient's abdomen, (b) ejecting from a distal
end of the tubular member a pair of prongs, (c) spreading the
prongs apart from one another to form a pair of jaws during the
step of ejecting, (d) moving the jaws towards an internal organ of
the patient to insert a portion of the organ between the jaws, and
(e) shifting the tubular member towards the prongs, thereby
partially closing the jaws about the organ.
Accordingly, a large internal organ such as a colonic section or a
portion of the aorta may be grasped and clamped in a method in
accordance with the present invention. In the event of a
traumatized or perforated organ such as the colon, the organ may be
temporarily clamped on opposite sides of the perforation to prevent
the spilling of fecal material into the abdomen, possibly infecting
other organs. The perforation may then be repaired or patched.
In an optional step in accordance with the present invention, the
organ is displaced relative to other organic tissues of the patient
by exerting a force on the tubular member and the jaws. This
displacement enables a surgeon to reach underlying tissues which
would otherwise be difficult to access.
Where the prongs are connected to an elongate rod member slidably
inserted into the tubular member, the step of ejecting includes the
step of pushing the rod member in a distal direction through the
tubular member.
Where the prongs are integral with one another and made of a
resilient material having a limited degree of flexibility, the
prongs may be collapsed towards one another by being drawn into the
distal end of the tubular member. Also, the step of spreading
includes the step of automatically spreading the prongs under the
action of internal stresses.
The insertion of the tubular member into the patient's abdomen is
accomplished by inserting the tubular member through a trocar
sleeve which is disposed in the abdominal wall of the patient.
Accordingly, the method is part of a laparoscopic procedure.
A surgical method comprises, in accordance with a further
conceptualization of the present invention, the steps of (i)
inserting a distal end of an elongate member into a patient's
abdomen, (ii) subsequently opening a pair of opposed arcuate arms
of a C-shaped clamping member connected to the elongate member at a
distal end thereof, thereby forming a pair of jaws, (iii) moving
the jaws towards an internal organ of the patient to insert a
portion of the organ between the jaws, and (iv) pressing the arms
towards one another to partially flatten the arms, thereby closing
the clamping member about the organ.
In an optional step in accordance with the present invention, the
organ is displaced relative to other organic tissues of the patient
by exerting a force on the tubular member and the jaws. This
displacement enables a surgeon to reach underlying tissues which
would otherwise be difficult to access.
As discussed above, the arms are preferably integral with the
elongate member and with one another and are made of a resilient
material having a limited degree of flexibility and an internal
spring force whereby the arms are maintained in an opened
configuration in the absence of a closure force.
Pursuant to another feature of the present invention, the step of
pressing includes the step of shifting an elongate tubular member
towards the jaws to engage the jaws in a camming action and to
partially close the jaws in opposition to the internal spring
force.
Again, the insertion of the tubular member into the patient's
abdomen is accomplished by inserting the tubular member through a
trocar sleeve which is disposed in the abdominal wall of the
patient. Accordingly, the method is part of a laparoscopic
procedure.
A surgical instrument or instrument assembly in accordance with the
present invention may be used to grasp and partially shift larger
internal organs of a patient such as the colon or the aorta. The
instrument assembly may be used in laparoscopic procedures, thereby
substantially facilitating the procedure in certain cases. The
instrument assembly may also be used as a clamp. For example, where
an organ such as the colon is perforated, a pair of instrument
assemblies in accordance with the invention may be used to
temporarily clamp the colon on opposite sides of the perforation
prior to a surgical closure of the perforation.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a partial longitudinal cross-sectional view of an
instrument assembly in accordance with the present invention,
showing a grasping or clamping member with a pair of prongs or arms
in a collapsed or closed configuration in the distal end of a
tubular member.
FIG. 2 is a schematic side elevational view of the instrument
assembly of FIG. 1, showing the grasping or clamping member with
the prongs or arms in an expanded or opened configuration outside
the distal end of the tubular member.
FIG. 3 is a cross-sectional view taken along line III--III in FIG.
1.
FIG. 4 is a schematic side elevational view of a modified
instrument assembly, showing a grasping or clamping member with two
pairs of prongs or arms in an expanded or opened configuration
outside the distal end of a tubular member.
FIG. 5 is a schematic perspective view showing a step in using the
instrument assembly of FIG. 4 to grasp a portion of a colon in a
laparoscopic procedure.
FIG. 6 is a schematic perspective view showing a subsequent step in
using the instrument assembly of FIG. 4 to grasp a portion of a
colon in a laparoscopic procedure.
DETAILED DESCRIPTION
As illustrated in FIGS. 1 and 2, a surgical instrument assembly 10
particularly utilizable in laparoscopic procedures for grasping and
temporarily displacing large internal organs such as a colonic
section comprises an elongate essentially rigid tubular member 12
and an elongate substantially rigid rod 14 slidably inserted in the
tubular member. Two prongs or arms 16 are connected to rod 14 at a
distal end thereof for forming jaws of a substantially C-shaped
clamping or grasping member 18 upon an ejection of the prongs from
the distal end of tubular member 12 by a distally directed stroke
of rod 14.
Prongs 16 are integral With rod 14 and with one another and are
formed with an internal spring force tending to maintain the prongs
in an opened or expanded configuration (FIG. 2) in the absence of a
closure force. Prongs 16 are made of a resilient material having a
memory, i.e., a limited degree of flexibility, allowing a loading
of the prongs into the distal end of tubular member 12 in a
collapsed configuration (FIG. 1), subsequent expansion (FIG. 2),
and partial closure during use of the instrument assembly to grasp
and temporarily displace a colonic section or other large internal
organ (FIG. 6).
The closure force for partially closing prongs or jaws 16 is
supplied by tubular member 12. Tubular member 12 cooperates with
prongs 16 in a camming action to press the prongs towards one
another upon relative motion of the tubular member and the prongs
towards each other.
As illustrated in FIG. 3, each prong 16 has a flattened transverse
cross-section with rounded edges.
In the alternative embodiment of FIG. 4, a modified surgical
grasper assembly 20 particularly utilizable in laparoscopic
procedures for grasping and temporarily displacing large internal
organs such as a colonic section includes an elongate essentially
rigid tubular member 22 and an elongate substantially rigid rod 24
slidably inserted in the tubular member. Two pairs of prongs or
arms 26 and 28 are connected to rod 24 at a distal end thereof for
forming jaws of two substantially C-shaped clamping or grasping
members 30 upon an ejection of the prongs from the distal end of
tubular member 22 by a distally directed stroke of rod 24.
Prong 26 and 28 are integral with rod 24 and with one another and
are formed with an internal spring force tending to maintain the
prongs in an opened or expanded configuration in the absence of a
closure force. Prongs 26 and 28 consist of a resilient material
having a memory which allows an alternate collapsinq of the prongs
into the forward end of tubular member 22 and an expanding of the
prongs into an expanded configuration.
The closure force for partially closing prongs or jaws 26 and 28 is
provided by tubular member 22. Tubular member 22 cooperates with
prongs 26 and 28 in a camming action to press the prongs towards
one another upon relative motion of the tubular member and the
prongs towards each other.
Prongs 16, 26 and 28 each have an arcuate configuration when
ejected from a distal end of the respective tubular member 12, 22
by a distally directed motion of rod 14, 24. Prongs I6, 26 and 28
are flattened out and pressed towards one another when retracted
into the distal end of tubular member 12, 22 by a proximally
directed motion of rod 14, 24 or, alternatively, when tubular
member 12, 22 is pushed in the distal direction over proximal end
portions of the prongs.
Prongs 26 and 28 likewise have have a flattened transverse
cross-section with rounded edges, as described hereinabove for
prongs 16 with reference to FIG. 3. The flattened cross-section
maximizes tissue contact area. The rounded edges serve to eliminate
any inadvertant cutting of an organ which is being grasped and
shifted by the instrument assembly.
As depicted in FIG. 5, a distal end of tubular member 12 or 22 is
inserted into a patient's abdominal cavity AC through a trocar
sleeve 34 which has been positioned in the abdominal wall AW.
During this insertion step, prongs 16 or 26 and 28 are disposed in
the distal end portion of the respective tubular member 12, 22.
Upon insertion of tubular member 12 or 22 so that the distal end
thereof protrudes into the abdominal cavity AC, rod 14 or 24 is
pushed in the distal direction through tubular member 12, 22 to
eject prongs 16 or 26, 28 from the tubular member. Prongs 16 or 26,
28 are spread apart under the action of their own internal spring
forces to form a pair of generally C-shaped grasping and clamping
jaws. The instrument assembly is then manipulated to move the jaws
or prongs 16 or 26, 28 towards an internal organ such as colonic
section CS to insert a portion of the organ between the jaws.
Tubular member 12, 22 is then shifted towards prongs 16 or 26, 28,
as illustrated in FIG. 6, to cam against the prongs and thereby
partially close the jaws or prongs 16, or 26, 28 about the colonic
section CS. Section CS may then be displaced relative to other
organic tissues of the patient by exerting a force on jaws or
prongs 16 or 26, 28 via tubular member 12, 22 and rod 14, 24.
After the laparoscopic procedure utilizing the instrument assembly,
tubular member 12, 22 is pulled in a proximal direction relative to
rod 14, 24 to enable an opening of prongs 16, 26, 28 under the
action of their own internal spring forces. Upon a manipulation of
the instrument assembly to remove the colonic section CS from the
grasping and clamping jaws, prongs 16, 26, 28 are then collapsed by
pulling on rod 14, 24 relative to tubular member 12, 22 to draw the
prongs back into the distal end of the tubular member.
Although the invention has been described in terms of particular
embodiments and applications, one of ordinary skill in the art, in
light of this teaching, can generate additional embodiments and
modifications without departing from the spirit of or exceeding the
scope of the claimed invention. It is to be noted, for example,
that surgical instrument assemblies in accordance with the present
invention may be utilized in operations other than laparoscopic
surgery. Even in open abdominal surgery, it is frequently necessary
to move an organ such as an intestine or an artery in order to
reach an underlying organ.
Accordingly, it is to be understood that the drawings and
descriptions herein are proffered by way of example to facilitate
comprehension of the invention and should not be construed to limit
the scope thereof.
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